New Surgical Approach for Lateralized Tympanic Membranes

Abstract

Objective: Lateralization of the tympanic membrane (TM) is a condition in which the visible surface of the TM is located lateral to the bony annular ring and loses contact with the ossicular chain of the middle ear. This condition typically occurs as a complication of otological surgery. Surgical correction of the lateralized TM and restoration of hearing may pose some problems because the grafts tend to relateralize after the revision. Though we have performed that surgical correction in our hospital, we have not had good success. Therefore we have changed our way of technique. Method: We now use a custom-made ceramic columella which is 2 times longer than the one we had previously used. It now directly reaches the lateralized TM from the stapes, instead of changing the position of the lateralized TM. Results: The merit of this approach is that relateralizing never occurs because we do not change the position of the TM. Some patients have improved hearing over 30 dB. The demerit of this approach is that the columellae sometimes fall or break through the eardrum because it is difficult to adjust the length because of long distance. So we have tried to work out the solution by accurately measuring the distance in units of 0.1 mm between the lateralized TM and stapes by using a 3D cone-beam CT. We also measure the distance throughout the operation. Conclusion: Though there is a short observation period, we have had good success with this approach. We will report our new surgical approach details with some case reports.